Modified Risdon approach using periangular incision in surgical treatment of subcondylar mandibular fractures

Nikolic, Z.; Jelovac, Drago; Šabani, Melvil; Jeremic, Jelena

doi:10.2298/sarh1608391n

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…Following this, an English study discussed this technical variant of the conventional Risdon approach. It is called the high submandibular approach (HSMA) or “Strasbourg approach,” which has sometimes been confused with other perimandibular or periangular approaches 5–7…”

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confidence: 99%

“…It is called the high submandibular approach (HSMA) or "Strasbourg approach," which has sometimes been confused with other perimandibular or periangular approaches. [5][6][7] The main modification, when compared with the conventional submandibular approach, was that the skin incision was higher with a surgical dissection below the superficial musculoaponeurotic system (SMAS), allowing for quick intraoperative identification and preservation of the facial nerve branches; however, there are few scientific publications regarding this approach.…”

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confidence: 99%

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Analysis of the High Submandibular Approach: A Critical Reapprasail of a Transfacial Access to the Mandibular Skeleton

Laganà

Arcuri

Spinzia

et al. 2022

Journal of Craniofacial Surgery

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Aim: In 2006 following the development of dedicated osteosynthesis plates, Meyer and colleagues reported a successful clinical study of condylar fractures treated by a modified submandibular approach; it was called high submandibular approach or “Strasbourg approach.” The aim of this study is to describe the high submandibular approach step by step. Case Series: Between January 2010 and December 2015 at the Maxillofacial Unit of the Hospital “Policlinico San Martino” 13 patients affected by subcondylar fracture underwent open reduction and internal with high submandibular approach. Surgery was uneventful in all patients; no infections occurred in any of the cases; the mean procedure duration was 89 minutes, ranging from 66 to 125 minutes. The mean hospital stay was 2.9 days, ranging from 2 to 6 days. At the 1-year follow-up, all patients had stable occlusion with a natural, well-balanced morphology of the face and adequate dynamic excursion of the mandible. Conclusions: The morbidity is negligible in terms of damage to the facial nerve, vascular injuries, and aesthetic deformity. The authors think that further prospective clinical trials are necessary to assess and eventually develop this approach.

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confidence: 99%

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confidence: 99%

Analysis of the High Submandibular Approach: A Critical Reapprasail of a Transfacial Access to the Mandibular Skeleton

Laganà

Arcuri

Spinzia

et al. 2022

Journal of Craniofacial Surgery

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“…Similar studies have shown a rate of facial nerve palsy of 7.5% to 17.2% with the retromandibular approach, 20,24 14% to 33% with the pre-auricular approach, 1,25 and 8% to 16% with the submandibular/Risdon approach. 26,27…”

Section: Discussionmentioning

confidence: 99%

Complications of the Transmasseteric Anteroparotid Approach for Subcondylar Fractures: A Retrospective Study

Gilliland

Ritto

Tiwana

2021

Craniomaxillofacial Trauma & Reconstruction

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Study Design: A retrospective analysis of patients with subcondylar fractures treated via a transmasseteric anteroparotid approach by the Oral and Maxillofacial Department at the University of Oklahoma. Objective: The goal of this study was to evaluate complications, morbidity, and safety with the transmasseteric anteroparotid approach for treatment of subcondylar fractures, and compare it to other findings previously reported in the literature. Methods: A retrospective study was conducted that consisted of 23 surgically treated patients in the past 2 years for subcondylar fractures. Only patients with pre-operative malocclusion and who underwent open reduction with internal fixation with the transmasseteric anteroparotid (TMAP) approach were included. Exclusion criteria included 1) patients treated with closed reduction 2) patients who failed the minimum of 1, 3, and 6-week post-operative visits. The examined parameters were the degree of mouth opening, occlusal relationship, facial nerve function, incidence of salivary fistula and results of imaging studies. Results: 20 of the surgically treated patients met the inclusion criteria. Two patients were excluded due to poor post-operative follow up and 1 was a revision of an attempted closed reduction by an outside surgeon that presented with pre-existing complications. There were no cases of temporary or permanent facial nerve paralysis reported. There were 3 salivary fistulas and 2 sialoceles, which were managed conservatively and resolved within 2 weeks, and 2 cases of inadequate post-surgical maximal incisal opening (<40 mm) were observed. Conclusion: The transmasseteric anteroparotid approach is a safe approach for open reduction and internal fixation of low condylar neck and subcondylar fractures, and it has minimal complications.

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“…Two studies determined the rate of FN injury after an RMTMAP approach, with rates of paralysis ranging from 5% to 16% 20,22 . Lastly, in the study of the modified Risdon approach by Nikolic et al, 19 2 patients (8%) developed transient paralysis that resolved within 6 weeks.…”

Section: Orif Approachesmentioning

confidence: 99%

Current Management of Subcondylar Fractures: A Systematic Review

Shikara

Bridgham

Ludeman

et al. 2023

Otolaryngol.--head neck surg.

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Objective. The aim of this study is to review the current literature on treatment of subcondylar fractures using traditional open reduction internal fixation (ORIF), closed reduction with maxillomandibular fixation (MMF), and endoscopic open approaches.Data Sources. PubMed, Embase, Cochrane CENTRAL, Clinicaltrials.gov, and WHO ICTRP.Review Methods. A comprehensive database search was performed in accordance with PRISMA guidelines. All English-only texts published in the last 20 years with ≥10 patients were included. Studies that included patients <16 years old were excluded.Results. Thirty-two studies met the final inclusion criteria. Nine studies compared ORIF with closed reduction using MMF, 12 studies evaluated ORIF via different approaches, and 10 studies evaluated outcomes after endoscopic approaches. Five studies reported significant improvement in mouth opening with ORIF compared to closed reduction. In 1 study that recorded patient-reported outcomes measure (FACE-Q scale), quality of life scores and patient satisfaction were significantly higher in the ORIF group. Among the 10 studies that used the endoscopic approach, transient facial nerve injury ranged from 0% to 10%. Conclusion.Several studies report better mouth opening, dental occlusion, and functional outcomes after ORIF compared to closed reduction, while some found no significant difference. Endoscopic approaches provide ease of access to the condyle with a low incidence of facial nerve injury. However, limitations include special equipment, longer operative times, and a steep learning curve using an endoscope. This review provides surgeons with an overview of the current literature on subcondylar fractures to allow for an individualized management approach for each patient.

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Modified Risdon approach using periangular incision in surgical treatment of subcondylar mandibular fractures

Cited by 12 publications

References 21 publications

Analysis of the High Submandibular Approach: A Critical Reapprasail of a Transfacial Access to the Mandibular Skeleton

Analysis of the High Submandibular Approach: A Critical Reapprasail of a Transfacial Access to the Mandibular Skeleton

Complications of the Transmasseteric Anteroparotid Approach for Subcondylar Fractures: A Retrospective Study

Current Management of Subcondylar Fractures: A Systematic Review

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